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Manipulation in Motion: A Video Companion to A Pocket Manual ofOMT is the DVD companion to A Pocket Manual of OMT: Osteopathic Manipulative Treatment for Physicians, which was published in 2006. This multimedia set is said to represent a “consensus statement” of seven osteopathic medical educators regarding the application of osteopathic manipulative treatment (OMT) techniques. (However, neither the book nor the video clearly identifies these seven educators.) Each of the eight individuals identified as authors or editors of this multimedia resource is a faculty member at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg, except for DVD coeditor Donald N. Pyle, II, OMS IV, who was a student at the time of publication. Five DO reviewers are also listed in the book.

The video contains the same basic content as (and duplicates the overall organization of) A Pocket Manual of OMT, excluding the first and last chapters, and is organized into four discs:

Posture, Screening Exam, Lower

Extremity Somatic Dysfunction

Pelvis, Sacrum, Lumbar Somatic Dysfunction

Thoracic, Rib, Visceral Somatic Dysfunction

Cervical, Cranial, Upper Extremity Somatic Dysfunction

Each disc has four main menus for finding content. These menus allow viewers to locate video clips of techniques by body region, by illness, and by alphabetical listing of all techniques, as well as to access text of the steps involved in applying each technique.

More than 200 video clips, each roughly a minute in length, are available. Each clip is professionally produced and clearly shows the featured manipulative technique. The dialogue is delivered slowly and distinctly by the DOs who perform the techniques. The text summaries placed alongside the images highlight and reinforce key steps of the techniques being shown. However, the viewer may need to play back a video clip a couple of times because concentrating on the images, the spoken description, and the summary text at the same time is rather difficult. Nevertheless, the DVD conveys the intended information well within the constraints allowed by visual representation of the palpatory maneuvers.

The authors of A Pocket Manual of OMT note that it is intended to teach osteopathic principles and practice “at a level of moderate depth.” They promote the book as a “comprehensive, practical, and readable” work to “refresh and expand skills” for attending physicians. Combined, the book and video admirably meet these goals—but only for experienced osteopathic physicians or for allopathic physicians who have been broadly trained in osteopathic principles and practice. No effort is made to provide the conceptual or evidential scientific background for the offered diagnostic and therapeutic techniques. Nor is any effort made to explain the relationships between the various models of osteopathic care or to discuss the numerous practical and scientific controversies and challenges attendant to the practice of OMT. Consequently, it would be inappropriate to recommend the book and video as sufficient learning resources to beginning osteopathic medical students or to third parties (eg, admini strators, bureaucrats, lay people, researchers, untrained clinicians across many professions).

Each of the chapters on diagnosis and treatment follows a similar organization, facilitating the manual's use as a white-coat pocketbook reference for the busy clinician. First, diagnostic techniques are listed and summarized by body region. Treatment techniques are presented in a parallel manner. The treatment technique section of each chapter also includes indications and contraindications alongside a step-by-step description of the OMT technique. Next, exercises recommended for that body region are presented, also in a step-by-step manner. Finally, brief thermal therapy and “stabilization” instructions are given. “Stabilization” is not defined, but it appears to cover a spectrum of interventions that include bite appliances, orthoses, and pro-lotherapy. Many helpful black-and-white photographs of OMT techniques and exercises are provided in all 13 chapters.

The book concludes, in chapter 13, with a brief summary of principles of application regarding certain OMT models in the primary care setting. For example, six somatic dysfunctions—dubbed “the dirty half dozen”—associated with chronic low back pain are listed.

This presentation of OMT techniques in A Pocket Manual of OMT meaningfully reflects the state of the art of osteopathic evaluation and treatment for patients with somatic dysfunction. The authors note that any one of the TART (tissue texture abnormality, asymmetry, restriction of motion, tenderness) criteria is sufficient for the diagnosis of somatic dysfunction. Because the osteopathic medical profession has not fully explicated the relationships among the four elements of TART, little more than a list of potential findings—incompletely admixed into standard categories of somatic dysfunction—is presented.

Along with the regional (ie, orthopedic) organization of the musculoskeletal system that is fully adopted in A Pocket Manual of OMT, this listing serves to reinforce the empirical use of OMT. Such use is unfortunate, because the osteopathic medical profession is justifiably challenged to move beyond this limitation by forces outside our profession and by our own tenets of osteopathic medicine—the body is a unit; the body possesses self-regulatory mechanisms; structure and function are reciprocally interrelated; rational treatment is based on an understanding of body unity, self-regulatory mechanisms, and the interrelationship of structure and function.

Three aspects of A Pocket Manual of OMT stand out as unique. First, each diagnosis and treatment chapter includes brief discussions of two relatively new categories of OMT—percussion vibrator technique and facilitated oscillatory release technique. Second, the authors note that the book is “the first manual medicine text to list indications and contraindications for every treatment, basing them on osteopathic standards of care, clinical common sense, and author experience.” The inclusion of indications and contraindications is an admirable practice that should be adopted by all authors who describe OMT or other manual techniques.

The lists of contraindications, though necessarily incomplete, are useful because they refer to various organic pathologic conditions and convey to the clinician the underlying principle of protecting injured, damaged, or diseased structures, as well as avoiding the risk of further injury. For example, contraindications for venous sinus drainage are presented as “intracranial bleed, craniofacial fracture, [central nervous system] malignancy or infection.” By contrast, the lists of indications are often vague, reflecting a lack of discrimination between symptoms, organic pathologic conditions, and dysfunction. Indications for venous sinus drainage, for example, are given as “headache, upper respiratory congestion, and other problems.” The musculoskeletal medical community at large faces a challenge in resolving this vagueness.

The third unique aspect of A Pocket Manual of OMT is the inclusion in each chapter of instructions for patients on how to perform physical exercises believed to complement OMT. For example, the chapter on lower extremities has directions for stretch and position-of-ease exercises for the Achilles tendon, gastrocnemius, hamstring, hip abductor, and patella. Although the addition of these stretching exercises sets a valuable precedent for OMT manuals, the precise dysfunctions that the exercises are intended to address are left to the clinician to sort out. The lack of precision in this component of the book is reinforced by the authors' descriptions of the exercises in orthopedic terms (ie, addressing specific muscles) rather than in osteopathic terms (ie, addressing specific patterns of dysfunction in postural and configurational contexts).

In summary—bearing in mind the previously mentioned limitations—I recommend both A Pocket Manual of OMT and Manipulation in Motion as valuable resources for the osteopathically trained clinician. The book and its companion DVD will likely also prove useful as succinct reviews for osteopathic medical students and residents preparing for practical examinations.